By Joseph E. Scherger, MD, MPH

Vice President, Primary Care, Eisenhower Medical Center; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles

Dr. Scherger reports no financial relationships relevant to this field of study.

SYNOPSIS: A prospective epidemiological cohort study of people 35-70 years of age in 18 countries showed that a higher intake of carbohydrates increased total mortality, while the intake of fats of all kinds did not. A higher intake of saturated fat reduced stroke mortality.

SOURCE: Dehghan M, Mente A, Zhang X, et al. Association of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): A prospective study. Lancet 2017 Aug 28. pii: S0140-6736(17)32252-3. doi: 10.1016/S0140-6736(17)32252-3. [Epub ahead of print].

The evidence is mounting that fats, including saturated fats from natural food sources, are not associated with cardiovascular or total mortality. Rather, high carbohydrate intake is associated with earlier mortality.

This large epidemiological study was performed prospectively with individuals 35-70 years of age enrolled starting in 2003 and followed for 5.9-9.3 years. The study included 135,000 individuals from 18 countries on five continents. There were 5,796 deaths and 4,784 major cardiovascular events. Higher carbohydrate intake was associated with greater total mortality (hazard ratio [HR], 1.28), and greater fat intake (all types of fats) was associated with lower mortality (HR, 0.77). There was no association between fat intake and cardiovascular disease, myocardial infarction, or cardiovascular mortality. Stoke rate also was lower in the high fat group (HR, 0.79).


Reanalysis of the information used to promote a low-fat diet was not based on good science.1 The sugar industry, wanting to avoid negative press on its products, played a major role in funding the effort to reduce fat intake.2 We are recovering from this misinformation, with leading academic investigators taking a stand and educating the public.3-5

All physicians should advise their patients to eat real food from nature without food labels as much as possible. Highly processed foods, especially grains and sweets, should be avoided. That is difficult since we have created a culture around cookies, cakes, candy, and pizza. The food industry is resisting this change, similar to how the tobacco industry behaved in the past. Physicians should be role models and champions of healthy eating.


  1. Ramsden CE, Domenichiello AF. PURE study challenges the definition of a healthy diet: But key questions remain. Lancet 2017 Aug 28. pii: S0140-6736(17)32241-9. doi: 10.1016/S0140-6736(17)32241-9. [Epub ahead of print].
  2. Taubes G. The Case Against Sugar. New York: Albert A. Knopf; 2016.
  3. Ludwig D. Always Hungry?: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently. New York: Hachette Book Group; 2016.
  4. Lustig RH. Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. New York: Penguin Group; 2012.
  5. Hyman M. Eat Fat, Get Thin: Why the Fat We Eat Is the Key to Sustained Weight Loss and Vibrant Health. New York: Little, Brown & Co; 2016.